IN THE MEGA-OBESE WEIGHT LOSS, BMI AND RESOLUTION OF WEIGHT-RELATED MEDICAL PROBLEMS VARY BY RACE: AN ANALYSIS OF 1,673 BOLD DATABASE PATIENTS

Paul Boulos, D.O. and Gus J Slotman, M.D.Department of Surgery, Inspira Health Network, Vineland, NJ

1ASMBS Conference 2015

DISCLOSURE

Unfortunately we have no financial conflicts of interest to disclose

ASMBS 2015

2Disclosure

Background Biliopancreatic bypass/duodenal switch (DS) is the bariatric surgery

option for many of the most extremely obese patients.

Duodenal Switch results for weight loss and resolution of obesity co-morbidities among the mega-obese are known.

Variation by race in pre-operative weight, BMI, and the frequencies of obesity co-morbidities in patients presenting for duodenal switch have been reported.

However, whether or not treatment responses to DS differ according to racial categories has not been investigated.

ASMBS 2015

3

Objective

To identify racial variations following Duodenal Switch in weight, weight loss, and BMI, and the

resolution of obesity co-morbidities.

ASMBS 2015

4

MethodsData from the Surgical Review Corporation’s BOLD database on 1,673 patients who underwent DS was analyzed retrospectively in four groups:

1. African-American (AA; n=131)2. Caucasian (C; n=1,380)3. Hispanic (H; n=48)4. Other (O; Pacific Islanders, Native Americans,

or >1 race recorded; n=108)

ASMBS 2015

5

MethodsWeight, BMI, and incidence of obesity-related co-morbidities

were tabulated in each of the four racial groups pre-operatively at 2, 6, 12, 18, 24, and 36 months following DS surgery.

Outcomes analysis used General Linear Models that included baseline and post-operative data, and were modified for binomial distribution of dichotomous variables.

Pair-wise comparisons of results for the African-American, Caucasian, Hispanic and Other groups versus each other were made at each interval.

Decreasing numbers of African-American, Hispanic, and Other patients precluded valid statistical analysis beyond 18 months.

ASMBS 2015

6

Methods Obesity Related Co-morbidities included along with weight, weight

loss and BMI:

ASMBS 2015

7

Cardiopulmonary HTN CHF Obstructive sleep apnea Pulmonary Hypertension Angina Obesity Hypoventilation Syndrome Asthma Hyperlipidemia PVD

Abdominal GERD Liver disease Cholelithiasis Panniculitis Stress/Urinary incontinence Abdominal hernia

Endocrine Diabetes Mellitus Polycystic Ovarian Syndrome

Somatic Pseudotumor cerebri Lower extremity edema Musculoskeletal pain Back pain Gout

Behavioral Mental health disease Psychological impairment Tobacco abuse ETOH abuse Substance abuse Support Group Attendance

African American ASMBS 2015

8

Weight and weight loss were greatest at 12 months but weight was highest pre-operatively (p<0.01). BMI at 6 months was also highest (p<0.05).

At 6 month asthma, stress urinary incontinence, diabetes, back pain, lower extremity edema, and musculoskeletal pain were lowest (p<0.05), as was 12 month dyslipidemia(p<0.05).

Lowest

• BMI • Asthma• Stress/Urinary

Incontinence• Diabetes• Back Pain• Musculoskeletal

Pain• Lower Ext

Edema• Dyslipidemia

Highest

Caucasian ASMBS 2015

9

Hypertension at 6 months was lowest (p<0.01), but 6 month liver disease and musculoskeletal pain were highest (p<0.05), as was 12 month cholelithiasis(p<0.01).

Lowest

• Liver Disease• Musculoskeletal

Pain• Cholelithiasis

• HTN

Highest

Hispanic ASMBS 2015

10

Diabetes, dyslipidemia, and lower extremity edema were highest among Hispanics at 6 months (p<0.05) as was 12 month abdominal skin problems/panniculitis (p<0.05).

Following duodenal switch, among Hispanic patients the incidence of GERD, stress urinary incontinence, lower extremity edema, depression, and alcohol use all increased.

The frequency of diabetes nearly doubled, and pulmonary hypertension tripled from baseline, while these parameters declined in the other racial groups.

Lowest

• Diabetes• Dyslipidemia• Lower Ext.

Edema• Panniculitis

• None

Highest

Other Racial Groups ASMBS 2015

11

Stress urinary incontinence, asthma, and back pain were highest among the Other group (p<0.01) and dyslipidemia was second only to Hispanics.

Liver disease was lowest among Other patients, compared to African American, Hispanic and Caucasian (p<0.05).

Lowest

• Stress/Urinary Incontinence

• Asthma• Back Pain

• Liver Disease

Highest

Results ASMBS 2015

12

Liver disease increased from the pre-operative percentages in African-Americans, Caucasians, and Hispanics but decreased in Other patients.

Early 2 month depression was highest in Caucasians and lowest in the Other group.

Outcomes for angina, congestive heart failure, peripheral vascular disease, pulmonary hypertension, obstructive sleep apnea, obesity hypoventilation syndrome, abdominal hernia, GERD, gout, polycystic ovarian disease, pseudotumor cerebri, psychological impairment, alcohol use, substance abuse, tobacco use, and support group attendance did not vary by race.

DISCLOSURE ASMBS 2015

13Results Review

• Stress/Urinary Incontinence

• Asthma• Back Pain

OtherCaucasianAfrican American Hispanic

• Diabetes• Dyslipidemia• Lower Ext.

Edema• Panniculitis

• Liver Disease• Musculoskeletal

Pain• Cholelithiasis

• BMI

Highest Incidence

DISCLOSURE ASMBS 2015

14Results Review

OtherCaucasianAfrican American Hispanic

Lowest Incidence

• Asthma• Stress/Urinary

Incontinence• Diabetes• Back Pain• Musculoskeletal

Pain• Lower Ext

Edema• Dyslipidemia

• HTN • None • Liver Disease

DISCLOSURE ASMBS 2015

15Results Review African-Americans lose the most weight, but remain heavier

than other racial groups, possibly related to higher pre-operative body mass. Nevertheless, African-Americans experienced the greatest resolution of seven obesity co-morbidities.

Caucasians resolved hypertension well, but musculoskeletal and hepato-biliary conditions persisted.

Hispanic patients benefited less from Duodenal Switch than did the other racial categories.

The Other grouped nationalities benefited less for stress urinary incontinence, asthma, back pain and dyslipidemia, but did well with obesity-related liver disease.

DISCLOSURE

Retrospective Study of BOLD Database

Six Asian Duodenal Switch patients in BOLD were too few for statistical analysis

Poor Follow Up after 18 months

Require larger populations among racial groups for longer term outcomes after Duodenal Switch

ASMBS 2015

16Study Limitations

DISCLOSURE

In the first 12 months after surgery, weight, weight loss, BMI and the resolution/persistence of weight-related co-morbidities vary significantly by race among the mega-obese patients who choose to undergo Duodenal Switch.

Knowing these racial variations in Duodenal Switch outcomes pre-operatively may help to optimize the management of mega-obese patients.

ASMBS 2015

17Conclusions

THANK YOU!

18ASMBS Conference 2015